The world’s polio problem continues to worsen. The World Health Organization announced Monday that we had hit a “public health emergency of international concern” in polio control, with ongoing spread in three countries—Pakistan, Syria, and Cameroon—despite this being a “low-transmission” time. In addition, cases are being diagnosed in other countries, including Nigeria (which had just received a promising report card from experts) and Afghanistan.
This was easy to see coming. Polio, like any vaccine-preventable disease, requires a moderately stable public health infrastructure, as well as a modicum of trust and flexibility, to assure that children are vaccinated. (Children are the ones at risk for the dreaded disease because immunity is conferred for life, either by the disease or the vaccine.) So in any community, when a wave of polio arrives, the only ones at risk are the young who didn’t receive a vaccine; teenagers and those older were either vaccinated according to plan or else contracted the disease and survived. Either way, part of the tragedy and poignancy of polio is its preferential spread to babies and toddlers.
In the newly affected countries, however, no such public health vision and stability can be found. Yet each country has its own story, it own unique reason for the crisis demonstrating how many ways a readily transmitted pathogen like polio virus can spread unless sustained efforts are made at control.
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Pakistan has had polio problem for many years, compounded by local distrust of vaccination and anything else that smacks of Western influence. As I have quoted before, in the face of a 2012 polio vaccine campaign in his country, a Pakistani lawyer claimed that “these vaccines are meant to destroy our nation…The [polio] drops make men less manly, and make women more excited and less bashful. Our enemies want to wipe us out.” Added to this is the threat to the lives of polio vaccinators who have been murdered in Pakistan and elsewhere as recently March of this year. Some consider this a continued furious response to the vaccine ruse perpetrated by the CIA in order to find Osama bin Laden.
Syria only recently has seen its continued civil war result in runaway infectious diseases. Here, destruction of stable, clean plumbing combined with a disrupted vaccine delivery infrastructure—refrigerators to store vaccine, people to distribute it, others to track who and where people have received a dose—have placed an enormous swath of young Syrians at risk. Global attention has led to some improved efforts, but the political climate as well as the locals’ bedrock distrust of the West make this epidemic appear far from over.
For Cameroon, the third of the countries signaled by WHO, the story is altogether different and altogether mysterious—a standard situation for infectious diseases and yet another reason for the ardent belief in wide and continuous vaccination, even when diseases appear near eradication. Here, there is no real civil war or jarring civil unrest; the economy though not booming, is not desperate; the political will appears to be present. Poliovirus strains, however, have been recovered by surveillance experts, and there is a suggestion that the circulation of the virus has not been interrupted by initiation of aggressive vaccine plans. Furthermore, Cameroon sits near a political tinderbox—the Central African Republic—where entry of an unchecked virus could exploit the issues currently experienced in Syria.
Outside of Cameroon, the reason for this mess is clear, and the solution clearer. The only question is whether political hostilities can be suspended long enough to prevent children from becoming paralyzed for life for want of a 14 cent vaccine. Public health programs usually work pretty well except in extremes of human behavior—warfare being one. Yet even during the Cold War, Soviet and American scientists worked together to identify and manufacture adequate amounts of vaccine to assure children’s safety.
Now though, the single humanitarian concession all could agree upon—that children should be protected—no longer is a rallying point. It is likely that the WHO, with effort, derring-do, money, and enough publicity, will be able to tame the latest conflagration of polio. But nothing they are doing will be able to reduce the underlying cause of the problem: although the world is now full of people motivated by profound religious belief, nothing at all is sacred.
